Robot Assisted Laparoscopic Prostatectomy (RALP)

Christopher-LuscombeLyndon-GommersallWhy have this procedure?

Laparoscopic or robotic assisted laparoscopic radical prostatectomy (also known as keyhole removal of the prostate) is an operation that may be suggested to manage early prostate cancer. It aims to cure prostate cancer by removing the entire prostate and surrounding glands (seminal vesicles). Surgery can also correct any obstruction to the flow of water that is caused by prostate enlargement. Alternatives to this surgery are active surveillance, radiotherapy (including brachytherapy), HIFU and cryotherapy. All these therapies, with their relative risks and benefits, should be discussed and considered before choosing the best individual treatment.

Radical prostatectomy is now the commonest major urological operation performed in many specialist hospitals in the UK. It can be performed either by an open operation or keyhole (laparoscopic and robotic). Most, but not all patients, are suitable for keyhole surgery and your surgeon will be able to advise about the best approach. The keyhole technique combines the cancer curing advantages of an open operation with better vision for the surgeon and reduced blood loss during the operation. Other advantages of keyhole surgery are smaller scars (better cosmesis and lower risk of hernias and infection), shorter hospital stay and quicker general recovery time.

Why choose us?

Our consultants are recognised experts in the field of keyhole prostate surgery. They were the first surgeons to perform laparoscopic radical prostatectomy surgery in the Greater Midlands Cancer Network (a region covering Kidderminster, Dudley, Wolverhampton, Shropshire and Staffordshire). They have visited by other surgeons wanting to learn the laparoscopic technique, and have helped such surgeons to introduce it to their hospitals.  They have been using the DaVinci robot to perform the laparoscopic radical prostatectomy since 2016. Analysis of UK data shows our excellent results. Updated data about our surgeons’ outcomes are available at the BAUS website.

Coming in for this procedure

Before the operation you will be invited to come to the hospital for a pre-operative assessment (including blood tests and heart trace). It is advisable to perform pelvic floor exercises, which are critical to regain continence following surgery, before and after the operation. On the day of the operation you will be asked to give written consent for the operation. You will be given some suppositories, which help clear the bowel before surgery. The operation is performed under general anaesthesia and usually takes between 3 and 4 hours. You will wake up with a catheter tube draining urine from the bladder that will stay for 10-14 days post-op. Pain is usually minimal and controlled by tablets. Patients are often fit to go home a day or 2 after surgery. There are risks and side effects associated with all forms of treatment and these should be carefully considered before surgery. Serious complications associated with major surgery (heart, lung, and thrombosis problems that could lead to death) are very rare. Damage to the back passage (rectum) or other internal organs is likewise rare. The commonest adverse effects of this surgery are incontinence, infertility and impotence. Incontinence usually improves in the first year after surgery, spontaneous erections rarely return and infertility is permanent. More details about the procedure are available on the patients homepage of BAUS (follow the links titled “I’m told I need…”

What happens during the procedure?

During the procedure, whilst under general anaesthetic 5 or 6 small holes are used to introduce instruments into the pelvis. These instruments are used to cut around the prostate and remove it, putting it first in a small bag. Some of the pelvic lymph glands may also be removed at the same time to check for signs of cancer spread.

The bladder is then sutured to the urethra, leaving a catheter in the penis.

Follow-up after this procedure

Regular follow-up with PSA blood test monitoring is required to ensure that the cancer has been eradicated. If the PSA fails to fall to very low levels (ideally less than 0.1 ng/ml, although many Doctors accept less than 0.2 ng/ml), or if it rises after being lower than this level, it is possible that the cancer is recurring. Early detection of cancer recurrence can often be salvaged and cure achieved by radiotherapy. Incontinence is a common early problem and you will be taught pelvic floor exercises to treat this. These exercises are critical and should be continued lifelong after this surgery. It is rare that incontinence fails to improve in the first year after this surgery, but if this is the case there are operations that might help. Impotence is also a common problem. This can sometimes be treated with tablets, but if these do not work then a vacuum device or injection into the penis can be very effective.

What next?

If you would like to discuss robotic/ keyhole prostate removal then please contact us and book a consultation with Mr Christopher Luscombe or Mr Lyndon Gommersall.